Agreement and reliability of parental reports and direct screening of developmental outcomes in toddlers at risk

Abstract

Developmental screening is a practice that directly benefits vulnerable and low-income families and children when it is regular and frequently applied. A developmental screening tool administered by parents called CARE is tested. CARE contains a compilation of activities to report and enhance development at home. Hundred and fifty-seven families in Bogotá (Colombia) initially responded to a call to participate in developmental screening tools’ validation and reliability study. All children (Average: 42.7 months old; SD: 9.4; Min: 24, Max: 58) were screened directly by trained applicants using a Spanish version of the Denver Developmental Screening test [i.e., the Haizea-Llevant (HLL) screening table]. After a first screening, 61 dyads were positive for follow-up and received a second HLL screening. Fifty-two out of 61 dyads use and returned CARE booklet after 1-month screening at home. The comparative analysis for parent reports using CARE and direct screening observation included (a) the effects of demographic variables on overall and agreement, (b) agreement and congruence between the CARE report classification and direct screening classification (“At risk” or “Not at risk”), (c) receiver operating characteristic analysis, (d) item-Level agreement for specific developmental domains, and (e) acceptability and feasibility analysis. Results and conclusions show the parental report using the CARE booklet as a reliable screening tool that has the potential to activate alerts for an early cognitive delay that reassure clinicians and families to further specialized and controlled developmental evaluations and act as a screen for the presence of such delay in four developmental dimensions.

El desarrollo infantil en el marco del ciclo vital puede resultar limitado si se eligen variables, además de la edad, que sólo se circunscriben a condiciones inevitables para la supervivencia. Este artículo recoge un intento por lograr una definición amplia, más allá del ciclo vital y en el marco de una estructura evolutiva del cuidado. Para tal objetivo, además de una discusión conceptual previa sobre una estructura evolutiva del cuidado y desarrollo socio-cognitivo, se presentan algunos resultados del Programa Inicio Parejo de la Vida. Se analizan los datos de 1177 participantes sobre actividades delectura, juego y otras más consideradas constitutivas e indispensables en la definición adoptada de desarrollo infantil y cuidado. Un primer análisis descriptivo de estos resultados indica una situación adversa para más del 80% de los niños participantes y genera dos hipótesis a discutir e indica una necesidad de atender con mayor urgencia la función de los agentes de cuidado y desarrollo en diversos niveles de atención.